If you become sick or are injured

If you become sick or are injured, present your health insurance card when undergoing examination or treatment to obtain the necessary medical care while paying just 30% of the applicable medical care costs. The amount paid at the hospital will be even lower for preschool children and elderly persons aged 70 or older.

  • * You can use your Individual Number Card as a health insurance card at medical care institutions or other facilities adopting the online eligibility verification system. (Requires advance registration on Mynaportal etc.)
Description
FAQ

Medical Care Benefits (for dependents, "Dependents' Medical Care Expenses")

Amounts paid

Copyment:
30%
Medical Care Benefits (Paid by the Health Insurance Society):
70%

The copayment may be even lower, depending on age.

Preschool children (20% copayment)

20%
80%

Persons aged 70-74(20% copayment) * Excluding those earning income equal to active workers

20%
80%

Under the health insurance system, the insurance benefits paid for nonoccupational sickness and injury are called "Medical Care Benefits" (for dependents, "Dependents' Medical Care Expenses"). You pay only 30% of medical care costs at the medical care institution because the Health Insurance Society covers the remaining 70%.

The society's additional benefits

(Paid per month, per person, per hospital)

Copayment
Copayment
20,000 yen		 The society's additional benefits
Patient Cost-Sharing Reimbursements
(Dependents' Medical Care Additional Sum)
  • ** This benefit excludes amounts paid as High-cost Medical Care Benefits, as well as costs such as meal expenses, accommodation expenses, and premium bed expenses during hospitalization, from the copayment amount.
  • ** The calculated amount will be rounded down to the nearest 100 yen.

Patient Cost-Sharing Reimbursements (For dependents: Dependents' Medical Care Additional Sum)

The Health Insurance Society later pays the amount of medical care costs paid at the hospital over one month minus 20,000 yen, as "Patient Cost-Sharing Reimbursements" (for dependents, "Dependents' Medical Care Additional Sum"). This payment is calculated and made automatically based on "the Rezept (medical cost details)" sent by the hospital to the Health Insurance Society. Payment will occur roughly three months after the month of the medical care.
See "When you incur high medical care costs: How High-Cost Medical Care Benefits are calculated" for a specific calculation example.

  • * However, because medical care costs related to infant medical care, child medical care, chronic specified children's diseases and disorders, the specified disease and disorder medical expense subsidy system for incurable and special diseases, the independence support medical care system, etc. are covered in whole or in part as public expenditures, confirmation might take a while.
    In this case, it might take three months or more before the money is transferred. In addition, there are cases where local governments (prefectures and municipalities) implement "medical expense subsidy systems" to subsidize the cost-sharing amount of medical care costs incurred by persons of age 18 or younger (High-Cost Medical Case Benefits), so—to prevent the double benefit provision of local government subsidies and Health Insurance Society benefits—we do not automatically provide High-Cost Medical Case Benefits. If you do not receive subsidies from your local government, please contact the Society.

Meals during hospitalization

If you are hospitalized, in addition to the 30% copayment on medical care costs, you must also pay yourself as meal expenses (referred to as "inpatient meal standard expenses") 460 yen/meal for up to three meals/day (260 yen/meal for patients with intractable diseases or specific chronic diseases of children).

While the actual cost of meals during hospitalization is 640 yen/meal (up to three meals/day) based on standard meal expenses, the Health Insurance Society pays the amount in excess of inpatient meal standard expenses, as "Inpatient Meal Expenses".

In addition, when an elderly person aged 65-74 is hospitalized at a convalescent facility, he or she pays meal expenses of 460 yen/meal and accommodation expenses of 370 yen/day (**1) (called "the standard personal cost burden for living expenses"). The Health Insurance Society pays the amount of actual costs in excess of this standard personal cost burden for living expenses, as "Inpatient Living Expenses".

  • **1: For patients with designated intractable diseases, the copayment for meal expenses is 260 yen, while the copayment for accommodation expenses is 0 yen.
  • **2: Costs are reduced still further for persons with low income. See here for more information.